Tuesday, December 18, 2012

Advocating on behalf of prison inmates can be a lonely task. Politicians and taxpayers are understandably focused on the kids and the kitchen table and are largely unsympathetic to the problems of convicted felons.

But there’s an issue developing inside prisons that’s threatening to move outside those walls. It’s looming as a potentially catastrophic public health risk to the mainstream population.

The rate of hepatitis C in prison populations has raised red flags for at least a decade at the National Institutes of Health and the Centers for Disease Control and Prevention. A 2005 study published in the Journal of Epidemiology and Infections shows prison inmates are infected at a significantly higher rate than the population as a whole. It also suggests that person-to-person transmission, typically through tattooing, continues during incarceration, making infection all the more likely as more time is spent in an institution.

If you don’t find this sobering, you should, because more than 95 percent of prison inmates are released back into society, according to U.S. Department of Justice statistics. An unacceptable number will carry hepatitis C back into neighborhoods and workplaces, where they will continue living with the undetected disease for decades. They will have ample occasion to spread it in their social circles.

The incidence of hepatitis C among Nevada prison inmates is not known because the Nevada Department of Corrections doesn’t administer a test for it upon entry.

Nevada CURE, a nonprofit group devoted to reforms in the prison system, wants a statute in Nevada requiring the state to administer a routine hepatitis C test to inmates entering the system.

There’s a humanitarian concern: Untreated hepatitis C causes a lingering, painful death, ravaging the liver. But consider, too, the expense of treating the end-stage complications of cirrhosis or cancer, compared with the smaller, controllable cost of the test and some antiviral treatments that are available.

Attempts to discuss a hepatitis C testing regimen with the state prison director have been largely ignored. During a face-to-face meeting in June, Director James G. Cox said immediately that cost would be a concern.

We aren’t sure whether Cox meant the cost of the tests or the cost from the Pandora’s box that would surely follow — the necessity to give lengthy treatments to the hundreds of inmates who would be expected to test positive. It could conceivably be tens of thousands of dollars per case. And the treatment is not always successful, either.

It’s a stiff price tag, but it’s less costly, and less dangerous for everyone, than the current alternative.

In fairness, Cox has a challenging package of responsibilities. He’s running a crowded prison system that has had safety and labor issues. He’s doing the job in the face of a tightening state budget that has left him with limited options.

At our June meeting, Cox said he would investigate the health procedures related to hepatitis C in other jurisdictions. Despite several follow-up reminders to his office, we’ve heard nothing back.

Since we expect the prison director to take seriously a threat to people inside and outside the walls, we followed up this fall with a public records request for information. The state took longer than the law allows to respond, and the documents we received raise more questions than they answer.

Las Vegas is no stranger to the horrors of hepatitis C. Our city is still living with the fallout from an episode in which innocent patients were infected with the virus in a clinical setting.

The disease also is in the spotlight nationwide. After discovering a higher-than-expected rate of infection in Baby Boomers, the CDC recently recommended a hepatitis C test for all adults born between 1945 and 1965.

The rate among incarcerated people is higher still and can’t be viewed as contained if it isn’t even monitored.

Nevada CURE does not regularly tug on the sleeve of the average citizen to ask for help getting something done. But we believe this issue is a cause for general alarm.

Travis N. Barrick is a Las Vegas attorney and vice president of Nevada CURE.

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